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Eur J Pain. 2019 Feb 1. doi: 10.1002/ejp.1374. [Epub ahead of print]

Non-pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

Author information

1
Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario, Canada, L1H 7L7.
2
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario, Institute of Technology (UOIT) and, Canadian Memorial Chiropractic College (CMCC), 2000 Simcoe Street North, Oshawa, Ontario, Canada, L1H 7L7.
3
Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario, Canada, L1H 7L7.
4
Undergraduate Education, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, Canada, M2H 3J1.
5
Graduate Education and Research Programs, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, Canada, M2H 3J1.
6
School of Public Health and Injury Prevention Centre, University of Alberta, 3-300, Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, Canada, T6G 1C9.
7
Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, 550 1st Avenue, New York, NY, 10016, United States.
8
Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, 60 Murray Street, 2nd Floor (Main), Toronto, Ontario, Canada, M5T 3L9.
9
Division of Clinical Education, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, Canada, M2H 3J1.
10
Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, Alberta, T6G 2G4.
11
Rehabilitation Research Centre, University of Alberta, 3-48 Corbett Hall Edmonton, Alberta, T6G 2G4.
12
Clinical Research, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario, Canada, K7L 2V7.
13
Department of Emergency Medicine, School of Medicine, Queen's University, 15 Arch Street, Kingston, Ontario, Canada, K7L 3N6.
14
Faculty of Medicine and Dentistry, University of Alberta, 116 St & 85 Ave, Edmonton, Alberta, Canada, T6G 2R3.
15
Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, Canada, M5T 3M7.
16
Institute for Work and Health, 481 University Ave, Toronto, Ontario, Canada, M5G 2E9.
17
University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
18
Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, Canada, M5T 3M7.
19
Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, Canada, M5T 3M7.
20
University of Ottawa, 505 Smyth Road, Ottawa, Ontario, Canada, K1H 8M2.
21
Western University, Dental Sciences Building, London, Ontario, Canada, N6A 5C1.
22
Open Policy Ontario.
23
Université de Montréal, 2375 Cote Ste-Catherine, Montreal, Quebec, Canada, H3T 1A8.
24
Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada, N6A 5C1.

Abstract

OBJECTIVES:

To develop an evidence-based guideline for the non-pharmacological management of persistent headaches associated with neck pain (i.e., tension-type or cervicogenic).

METHODS:

This guideline is based on systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience includes clinicians; target population is adults with persistent headaches associated with neck pain.

RESULTS:

When managing patients with headaches associated with neck pain, clinicians should: 1) rule out major structural or other pathologies, or migraine as the cause of headaches; 2) classify headaches associated with neck pain as tension-type headache or cervicogenic headache once other sources of headache pathology has been ruled out; 3) provide care in partnership with the patient and involve the patient in care planning and decision-making; 4) provide care in addition to structured patient education; 5) consider low load endurance craniocervical and cervicoscapular exercises for tension-type headaches (episodic or chronic) or cervicogenic headaches >3 months duration; 6) consider general exercise, multimodal care (spinal mobilization, craniocervical exercise, and postural correction), or clinical massage for chronic tension-type headaches; 7) do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension-type headaches; 8) consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization, and exercises; and 9) reassess the patient at every visit to assess outcomes and determine whether a referral is indicated.

CONCLUSIONS:

Our evidence-based guideline provides recommendations for the conservative management of persistent headaches associated with neck pain. The impact of the guideline in clinical practice requires validation. This article is protected by copyright. All rights reserved.

KEYWORDS:

clinical practice guideline; disease management; headache; management; neck pain; practice guideline; therapies; therapy; treatment

PMID:
30707486
DOI:
10.1002/ejp.1374

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